Utah Diabetes Telehealth Oct 19, 2011 Pre-Test

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Welcome to the Utah Diabetes Telehealth Program!

The following registration will take a few minutes to complete. Your responses will be kept confidential, help make this program successful and allow us to provide you with a FREE certificate of your participation in this continuing education program, if requested.

Please, fill out the post-test at the completion of this program (required for continuing education units). The Sign-In Form is only recommended for groups.

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1.To receive a certificate, please provide your name* as you would like it printed on the certificate, e-mail address*, zip code*, and phone number* below:

Name*:

Clinic/Hosp/Dept:

Title:

State:

ZIP*:

Email Address*:

Phone Number*:

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2.Indicate your credentials so the appropriate number of hours can be included on your certificate (Nurse = 1.5 hours, Dietitian = 1.0 hour, Other = 1.0).